Rural American Indian veterans have unique healthcare needs and face numerous barriers to accessing healthcare services. Over the past decade, the Department of Veterans Affairs in conjunction with the University of Colorado Denver has turned to the promising field of telemental health to develop a series of videoconferencing-based clinics to reach this vulnerable population and improve mental healthcare services. The ongoing development, implementation, and expansion of these clinics have been assessed as part of a program improvement. The outcomes of these assessments have been documented in a series of published articles, controlled studies, program and case reports, and model descriptions. This article summarizes a decade of experience with the American Indian Telemental Health Clinics, the clinic model, and the literature arising from these clinics and presents lessons learned while establishing, maintaining, and evaluating these clinics. The ability to tailor the clinics to individual sites and cultures and to provide various services has been critical to the operation of the clinics. Culturally specific care through culturally knowledgeable providers, onsite tribal outreach workers, and collaboration with community services has proven essential in operating the clinics, as well as building rapport, trust, and engagement with the target patient population. It is hoped that the lessons learned and practices presented here can not only assist others working to improve the care for rural Native veterans but also serve as a model in the use of telemental health services for improving care and access to rural veteran and non-veteran populations.

Objective This study examined use by American Indian and Alaska Native veterans of services provided by specialty telemental health clinics focused on posttraumatic stress disorder. These clinics offer services via videoconferencing to address challenges faced by rural veterans in accessing care. Methods A retrospective chart and electronic medical record review was conducted for 85 male veteranswho used services at two rural telemental health clinics in 2006 and 2007. Service use and other characteristics were documented before and after their initial telemental health intake. Results After intake, patients use of any health services (both general medical and mental health services) significantly increased (p<.01), as did the proportion receiving appropriate psychotropic medication (p<.01). Conclusions This first examination of service use by American Indian and Alaska Native veterans at specialty telemental health clinics will help inform research and clinical strategies for improving telemental health for this and other rural populations.

American Indians and Alaska Natives serve at the highest rate of any US race or ethnic group, yet are the most underserved population of Veterans and do not take advantage of the Department of Veterans Affairs (VA) benefits and services. Barriers to seeking care include stigma, especially for mental health issues; distance to care; and lack of awareness of benefits and services they are entitled to receive. In response to this underutilization of the VA, an innovative program--the Tribal Veterans Representative (TVR) program--was developed within the VA to work with American Indians and Alaska Natives in rural and remote areas. The TVR goes through extensive training every year; is a volunteer, a Veteran and tribal community member who seeks out unenrolled Native Veterans, provides them with information on VA health care services and benefits, and assists them with enrollment paperwork. Being from the community they serve, these outreach workers are able to develop relationships and build rapport and trust with fellow Veterans. In place for over a decade in Montana, this program has enrolled a countless number of Veterans, benefiting not only the individual, but their family and the community as well. Also resulting from this program, are the implementation of Telemental Health Clinics treating Veterans with PTSD, a transportation program helping Veterans get to and from distant VA facilities, a Veteran Resource Center, and a Veteran Tribal Clinic. This program has successfully trained over 800 TVRs, expanded to other parts of the country and into remote areas of Alaska.

Our findings may aid in developing strategies for adopting and implementing promising native-specific programs and services for AI/AN veterans, and may be generalizable for other veteran groups.

Demographic and service-related characteristics of rural Native veterans who accessed VA care differ from those of rural non-Native veterans. Identifying specific health care and service use characteristics will assist in the development of appropriate policy and programs to serve rural Native veterans.

Using cases and empirical data from a research and development project at a Danish prevention center, this study explores whether and how the use of narrative dietary counseling can strengthen dietitians' relationships and collaboration with clients who are chronically ill. The results of the study show that the use of whiteboards and narrative learning strategies, such as exploration, externalization, evaluating questions, and unique outcomes, were experienced by the dietitians to provide advantages over the existing practice, which used motivational interviewing alone. Specifically, narrative dietary counseling empowered clients and improved relationship building and collaboration between client and dietitian.

Objective to understand the perception of primary care nurses about the repercussions of the pandemic on the performance of cervical cytopathological exam. Method qualitative, descriptive study, with data analyzed by Content Analysis. Twelve nurses working in primary care in Foz do Iguaçu, PR, between February and March of 2022, were interviewed. Results three thematic categories emerged that discussed the damages of the pandemic for cervical cancer screening; need to reorganize the service, highlighting the low adherence; and lack of strategies for the return of health practices. Conclusion and implications for practice in the pandemic, there was a suspension of preventive collection and after the critical period, the fear of contamination by women, lack of inputs and human resources made it difficult to resumption of service. It’s relevant for practice to develop actions and strategies that encourage the performance of the exam, in order to reduce morbidity and mortality from this neoplasm.